Column: OD rates high in Sudbury, Northern Ontario

One of the new-ish Ontario government’s more surprising decisions thus far has been its coming around to tolerating safe-injection sites for opioid users. The chances didn’t look so hot when it launched a review of the evidence, which is overwhelmingly supportive of the harm reduction approach. And when health minister Christine Elliott candidly admitted that “whatever I think is really not the point,” the prospects seemed dire indeed. The point is what Premier Doug Ford thinks, and he has always described himself as “dead against” the idea.

But last month, Elliott said the review had found what supporters said it would: Inasmuch as safe injection sites prevent fatal overdoses on their premises with roughly 100 per cent efficiency amidst a horrifying nationwide epidemic of overdose deaths, they work really, really well.

You might wish they would do more than that. Some still indulge the fantasy distinction between “letting them shoot up” and “sending them to treatment.” But preventing people from dying is pretty damn impressive all by itself. “The evidence clearly demonstrated that these sites were necessary,” Elliott said at a news conference.

Now, however, harm reduction proponents claim the system is under bureaucratic attack. Under the new banner of “consumption and treatment services” (CTS), the province will only approve and fund sites that exist in “incorporated health care or community-based organizations that offer integrated, wrap-around services.” That means no more “pop-up” overdose-prevention sites, which had previously been approved on a six-month basis.

These healthcare facilities must provide “onsite or defined pathways to addictions treatment services” and other social supports; must have “a designated health professional … present at all times” (i.e., not just volunteers trained in overdose response); must have a “foot wash station” installed for some reason; must be more than 600 metres from any other CTS facility, and ideally not within 200 metres of a licensed child care facility, park or school (which seems to threaten at least two existing sites in Toronto); must offer “culturally, demographically and gender-appropriate” services; and must be compliant with the Accessibility for Ontarians with Disabilities Act.

Facilities can continue to operate while they navigate the reapplication process, which proponents claim is far too laborious. It includes submitting a report of consultation activities with neighbourhood stakeholders, police and city officials, as well as a “community engagement and liaison plan” for ongoing consultation. Facilities must report on a monthly basis everything from the number of overdoses to the number of clients referred to treatment to the number of times police were called to the facility.

The process was hardly greased lightning beforehand. Comprehensive reporting is a good idea. And officially tasking these facilities with cleaning up needles and other drug paraphernalia in their neighbourhoods is also a good idea, if only to maintain community support. Safe injection sites are supposed to help with such problems, but there is no question they have worsened in some parts of Toronto. (Harm reduction facilities may attract drug users to a given neighbourhood, but they have limited hours.)

Still, all this red tape is a bit off-brand for Ford’s open-for-business government. Once conservatives get past the ideological hurdle of harm reduction, they ought to be impressed by its simplicity: Two volunteers in a tent with a bunch of naloxone kits and $200 in supplies from any pharmacy can provide the most basic service, which is ensuring that people do not die. Those two volunteers are most likely to erect their tent where the need to stop people from dying is greatest, and there is no good reason we should want to stop them from doing so — even if it’s within 200 metres of a playground.

Would we rather they shoot up in the playground? Would we rather they die unnoticed in an alley?

Strangest of all, the government has capped the number of facilities at 21. As it stands, federally approved facilities exist only in Toronto, Ottawa and London; there are pending applications in Guelph, Hamilton, Kingston and Thunder Bay. Even if they were all approved, that leaves a lot of Ontario cities with big-time opioid problems with no harm reduction services on offer. Toronto boasts the highest death toll, but its mortality rate of 10.4 per 100,000 pales in comparison to the health units containing Thunder Bay (20.1), Sault Ste. Marie (19.1), Sudbury (17), Brantford 16.9), Niagara Falls and St. Catharines (16.1).

Some of those communities remain dead-set against safe-injection sites. But why on earth would we preemptively shut the door on those that come around? Once you accept the basic, blunt premise of harm reduction — that you can’t get clean if you’re dead — slapping arbitrary restrictions on it becomes indefensible. Or it ought to, anyway.